title: Scleritis: challenges in immunopathogenesis and treatment.
abstract: Scleritis is an uncommon disease characterized by inflammation of the sclera and adjacent ocular structures. Recent studies have led to significant progress in understanding the epidemiology, immunopathogenesis, severity assessment, treatment, and prognosis of this potentially sight threatening disease. Despite these advances, significant challenges remain regarding our understanding of the mechanisms of scleral destruction and inflammation, and the rational approach to treatment. Information from studies in associated systemic diseases and vasculitis and a small number of studies of ocular tissue has revealed the prominent role of T and B cells, autoantibodies, immune complexes, and cytokines, such as TNF-alpha. These studies have prompted clinical trials that have demonstrated the effectiveness of anti-TNF, anti-B cell therapy, systemic immunosuppression, and more recently the use of local sub-conjunctival steroid treatment.
authors.affiliation: School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Denis
authors.initials: D
authors.lastname: Wakefield
authors.forename: Nick
authors.initials: N
authors.lastname: Di Girolamo
authors.forename: Stephan
authors.initials: S
authors.lastname: Thurau
authors.forename: Gerhild
authors.initials: G
authors.lastname: Wildner
authors.forename: Peter
authors.initials: P
authors.lastname: McCluskey
mesh_terms: D000818:Animals; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D004195:Disease Models, Animal; D006801:Humans; D015423:Scleritis / Q000453:epidemiology / Q000209:etiology / Q000276:immunology* / Q000628:therapy*; D014657:Vasculitis / Q000276:immunology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic